Clinical and Radiological Outcomes of Rotator Cuff Repair With Versus Without Biceps Tenotomy: A 3D Volumetric Analysis of the Subacromial Space

INTRODUCTION: This study aims to compare the clinical and radiological outcomes of arthroscopic rotator cuff repair (RCR) performed with versus without concomitant long head of the biceps tendon (LHBT) tenotomy, including a three-dimensional (3D) volumetric analysis of the subacromial space.
METHODS: This retrospective study included 43 patients who underwent unilateral arthroscopic single-row repair for small to medium supraspinatus tears between May 2021 and July 2023. Group I (n = 24) underwent RCR with LHBT tenotomy, while Group II (n = 19) underwent RCR alone. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the American Shoulder and Elbow Surgeons (ASES) score. Subacromial volume was evaluated using 3D MRI volumetric measurements obtained pre- and postoperatively.
RESULTS: In Group I, the mean VAS score decreased from 6.17 to 1.58 and the ASES score increased from 38.21 to 81.13 postoperatively. In Group II, the VAS score decreased from 5.95 to 1.37 and the ASES score increased from 42.32 to 82.47. Both groups showed significant postoperative improvements, but no intergroup difference was observed. Subacromial volume increased from 3.79 cm³ to 4.94 cm³ in Group I, and from 3.85 cm³ to 4.90 cm³ in Group II. Although both groups exhibited a significant postoperative increase in subacromial volume, no intergroup difference was observed in postoperative measurements.
DISCUSSION AND CONCLUSION: In this cohort, no statistically significant additional benefit of concomitant LHBT tenotomy was demonstrated in terms of pain relief, functional improvement, or 3D subacromial volume restoration compared with rotator cuff repair alone.

Keywords: ASES score, biceps tenotomy, rotator cuff repair, subacromial volume, three dimensional measurement.